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On November 18, 2016, Sky commented on 23andMe and You! :

Thank you for the article. 23andme undoubtedly offers an interesting product, however I do not see their current offering as a particularly useful product for either consumers, or pharmaceutical companies.

For an individual, the majority of the information is quite generic, and I question whether anyone actually acts on say a 5% risk of disease y. Therefore, I can only see downside – potential for apprehension, paranoia, and over investigation by doctors. I am a strong believer in harnessing the power of genetics in order to improve human health, however this is just not the right setting in my opinion. Unless a certain test has a certain actionable treatment that can impact upon one’s life expectancy, 23andme is in my view nothing more than a gimmick.

With regard to Pharmaceutical companies, one key issue with the data is that it lacks a link to patient’s clinical data. This data would be far more valuable if linked to patient’s clinical data, as one would be able to perform big data analysis in order to improve the understanding of genetics and its relationship with disease. Pharmaceutical companies could then use the insights from this data analysis in order to develop new therapeutics.

I therefore have concerns about 23andme’s long term future, however I hope that they move away from consumers and try to focus on actually impacting upon patient’s lives by providing genetic tests to those who need it most at a low cost in order to increase access to such tests.

On November 18, 2016, Sky commented on The Failed Launch Of :

As you nicely pointed out, the launch of the national healthcare exchange website was a disaster. It really raises key questions as to how large projects within the civil service are run, and one must consider how the government can leverage the nation’s technological expertise in order to push forward, not backwards its agenda. For instance, could the government have worked with a Silicon Valley startup in order to develop a solution which was much more nimble at a fraction of the cost? Strong leadership and project management skills are undoubtedly key. Nonetheless, it is great that the exchanges ultimately worked. Whilst one can argue with certain points of implementation, the Affordable Care, by insuring 15 million previously uninsured people, undoubtedly had a positive impact on social justice in the USA. The recent election threatens this triumph, however one hopes that expanding healthcare accessing will remain a key agenda of the new administration.

On November 18, 2016, Sky commented on Cerner and the Digitization of U.S. Healthcare Data :

Thank you for the post. Cerner is undoubtedly in a great position as the incumbent EHR supplier to many hospitals. However, they will become increasingly under pressure for healthcare technology startups aiming to take a slice of the EHR pie. Cerner must therefore ensure that it does not fall a victim of its own success, and that it does not lose sight of what it’s younger, nimbler competitors are doing. Large incumbents in many industries throughout history have been slow to adapt to ever changing landscapes, and so Cerner must ensure it does not follow this fate. I also feel that an aggressive M&A strategy of young startups developing technology which could be implemented into their system is a potential means of Cerner ensuring it maintains its position as the market leader.

On November 18, 2016, Sky commented on Apple: Digital Healthcare Innovation :

Thank you for the article. Apple clearly have a tremendous platform upon which they can look to really go about changing peoples’ health. However, at present, I feel that their approach has been somewhat fragmented, and not particularly impactful. In my opinion, the key catalyst is going to be wearable medical devices which can interact with one’s iPhone. A blood sugar monitor which could beep whenever your glucose level is not optimal, or a EKG monitor which could call the ambulance as soon as it detects a heart attack, would really revolutionize healthcare. I have no doubts that such solutions are only a matter of time, and I hope that Apple remain at the forefront when this digital revolution of healthcare monitoring occurs.

On November 18, 2016, Sky commented on Will Telemedicine Re-shape Our Healthcare Industry? :

Thank you for the informative article. With healthcare costs in the USA at 17.6% of GDP and showing no signs of slowing, innovative ways of cutting costs in healthcare are undoubtedly needed. On the surface, Teladoc undoubtedly appears to be such a solution. However, I was also wondering if Teladoc could in fact increase total healthcare costs. By lowering the barrier to a patient accessing healthcare, they will undoubtedly use it more often, and further, this will likely lead to more unnecessary investigations. One could almost argue that for many patients, the time/physical barrier to seeing a doctor in fact means that healthcare costs are lower than they otherwise would be. It is often said that in the USA, for instance, the lack of a primary care physician acting as a gateway to specialist care leads to many unnecessary appointments and tests as many patients see individual specialists as opposed to a single primary care physician who co-ordinates their care – Teladoc merely exacerbates this issue. In addition, Teladoc medical notes will likely not be linked to a patient’s other medical records; which could in turn cause a host of issues.

Overall, therefore, I am optimistic about the future of telemedicine, however am extremely cautious of its expansion without assessing whether it actually has a positive impact on payor’s pockets and patient’s health via rigorous academic studies.

Thank you for the article. Sanofi has indeed done a great job in developing the dengue vaccine – a projected it had worked on for around two decades; so it is great to see success come from the project. However, Sanofi must be aware of the impending competition from Takeda, who are currently in the process of taking their dengue vaccine through phase III trials ( Some data suggests that Takeda’s vaccine may prove more efficacious, and this could lead to a price ware with Sanofi. It is important for Sanofi to therefore capitalize on its first mover advantage by signing up for large vaccination programs with countries affected by dengue, as it has been doing, with large vaccination programs already launched in Philippines and Brazil. With time, climate change has the potential to shift mosquito distribution – which could in turn impact on dengue distribution, and therefore with time, which will provide Sanofi with a shifting geographic target market.

On November 7, 2016, Sky commented on Health Care without Harm :

Thank you very much for this interesting article. Having spent time working in hospitals, one thing that really strikes me is the wastage of physical materials. In particular, the wrapping around medical products, and the disposable medical products themselves. As you mentioned in section 3.1, as a medical device manufacturer, J&J could make great strides in looking to increase the sustainability of its packaging, and perhaps looking into ways of producing devices that are less wasteful (eg. using less physical materials, and recycle materials within the devices themselves). An interesting point worth considering is that as you noted, healthcare will be effected by climate change. Can J&J look to capitalize on this financially and socially, by for instance working on developing drugs that will treat conditions whose incidence will increase as a result of climate change.

Thank you for the interesting article and great insight. You mentioned Novartis’ need to respond quickly in order to provide vaccines; this certainly would have been the case, however Novartis actually sold their Vaccines business to GSK in 2015 in an asset-swap deal in which Novartis acquired GSK’s oncology assets, and therefore is no longer in the vaccines business ( One key aspect of Novartis’ operating model related to climate change which it should consider is how it might go about rapidly providing urgent medications during climate change-induced natural disasters.

On November 7, 2016, Sky commented on Malaria: A Hot Mess in a Hot World :

Thank you for this article. GSK have indeed done great work in developing the malarial vaccine RTS,S. However, I am still cautious about this vaccine; clinical trial data was unfortunately dissapointing: “Over the full duration of the trial, vaccine efficacy against clinical malaria in infants was 27% in the group that received four doses of RTS,S (3 doses at 6, 10 and 14 weeks of age, and a fourth dose 18 months later); and 18% in the group that did not receive the fourth dose of the vaccine.”( Therefore, whilst GSK have done an admirable job in developing this vaccine, I question whether the economics of broadly rolling out this vaccine (at a cost of c. $5/vaccine), when potentially more effective vaccines are under development ( It is certainly a difficult public health issue, and I suspect that the vaccine will ultimately not be widely rolled out.

On November 7, 2016, Sky commented on Is the Hospital Industry “Feeling Under the Weather”? :

Thank you for the insightful article. I was particularly interested by your suggestion of rewarding credits based on healthcare consumption. I think that this is a great idea and was thinking about how one might go about implementing this. With hospitals shifting to value-based healthcare models, where payments are linked to health outcomes, why can’t some payments also be linked to climate change? In this respect, perhaps a metric such as carbon emissions per hospital bed could be calculated, and based on this, certain payments made (or not made) to the hospital. This would clearly be controversial, but would certainly be a way of attempting to align incentives. Perhaps the credits could form the basis of certain tax credits – a solution likely to be more palatable than changing the way medicare and medicaid reimburse hospitals. As you mentioned, hospitals are a great carbon emitter, and helping them make not just their patients, but also the climate healthier should be a key priority.